Saturday, March 30, 2024

Motivational Interviewing (MI) in the Field of Addiction Medicine


Ruwan M Jayatunge M.D. PhD 

Motivational interviewing (MI) helps to change longstanding behaviors that pose significant health risks, and MI is considered an important tool in addiction treatment. Moreover, MI is a tool designed to facilitate behavioral change in the patient by resolving the ambivalence to change (Miller & Rollnick, 2002). MI is facilitating health-related behavioral change in substance abuse, such as tobacco, alcohol and others (Dunn et al., 2001). Sim and team (2009) state that MI is about creating a climate that facilitates change, and can help build motivation, commitment and confidence to change.  

As described by Hall and colleagues (2012), Motivational interviewing is a patient-centered counseling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and empower the patient. MI can be described as a collaborative and evocative process that honors patient autonomy (Miller & Rollnick, 2002). It is focused on patient coaching rather than instructing the patient and is described as a non-confrontational, non-judgmental and supportive type of counseling (Al Ubaidi ,2017). MI helps to promote and increase patient motivation towards positive behavioral change, as well as to explore and then resolve any negative issue(s) or experience(s) of conflict. 


MI focuses on client desires, thoughts and feelings as a way to encourage clients to express their own barriers to change and to explore and resolve ambivalence toward behavioral change (Wu & Lin 2009). The patient's motivation cannot be imposed by an external entity; it is the patient's task to resolve their ambivalence, and the counselor should not concentrate on persuading the patient to change their behavior.  (Al Ubaidi ,2017). Readiness to change is a dynamic process, and ambivalence is hindering positive change. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual. Ambivalence is evident in substance abuse.


MI strategies reduce the paternalistic therapeutic style, and the practitioner avoids an authoritarian stance. During the sessions, a partnership between the patient and practitioner is formed. Joint decision-making occurs. The practitioner acknowledges the patient’s expertise about themselves. The practitioner activates the patient’s own motivation for change by evoking their reasons for change. It is the patient’s own reasons for change, rather than the practitioner’s, that will ultimately result in behavior change. The therapist is using reflective listening skills and accurate empathy, where the practitioner seeks to understand the patient’s perspective, thoughts and feelings without judging, criticizing or blaming. Assisting patients to identify discrepancies between their current behavior and future goals or values about themselves as a person, partner, parent, or worker is a powerful motivator that helps ‘tip the balance’ toward change.


MI activates motivation for change. It uses a guiding communication style that invites people to consider their own situation and find their own solutions to situations that they identify as problematic and that are preventing change (Christie & Channon, 2014). The counselor adopts a "goal-directed approach" with a "patient-centered counseling style" that may enhance the patient's desire to change and decrease resistance (Miller & Rollnick ,2002). Research indicates that MI is equivalent to or better than other treatments such as cognitive behavioral therapy (CBT) or pharmacotherapy (Burke et al., 2003).


Al Ubaidi BA (2017) Motivational Interviewing Skills: A Tool for Healthy Behavioral Changes. J Fam Med Dis Prev 3:069.

Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled trials. J Consult Clin Psychol 2003;71:843–61.

Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab. 2014 May;16(5):381-7. doi: 10.1111/dom.12195. Epub 2013 Sep 1. PMID: 23927612; PMCID: PMC4237607.

Dunn, C,. Deroo ,L., Rivara, F.P.(2001). Addiction. 96(12):1725-42.

Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques - facilitating behaviour change in the general practice setting. Aust Fam Physician. 2012 Sep;41(9):660-7. PMID: 22962639.

Miller, W.R., Rollnick, S. (2002).Motivational Interviewing: Preparing People for Change. 2nd ed. New York: Guilford Press.

Sim MG, Wain T, Khong E. Influencing behaviour change in general practice - Part 2 - motivational interviewing approaches. Aust Fam Physician. 2009 Dec;38(12):986-9. PMID: 20369152.

Wu CC, Lin CC. [The application of motivational interviewing in nursing practice]. Hu Li Za Zhi. 2009 Apr;56(2):89-93. Chinese. PMID: 1931

Thursday, March 28, 2024

Alexander Pushkin and Mikhail Lermontov - Who Shared a Common Fate


Ruwan M Jayatunge M.D. 

Alexander Pushkin and Mikhail Lermontov were Great Russian romantic poets who lived in the 19th century. They knew each other and adored each other’s work. Both were rebellious in nature. Alexander Pushkin was the pioneer of Russian literature. Among his major works Ruslan and Ludmila  , Evgenii Onegin, and Boris Godunov can be considered the greatest masterpieces of Russian literature. Although Pushkin was a genius in literature, the Russian Czar did not tolerate his poems, which carried elements of protests. Pushkin was a daring activist who was secretly involved with an underground revolutionary group and also publicly expressed his support for the Decembrist uprising, which demeaned feudal reforms. As a result of his rebellious attitude, Pushkin was banished from St Petersburg.
In 1827, he composed the ode titled The Poet
Until he hears Apollo's call
To make a hallowed sacrifice,
A Poet lives in feeble thrall
To people's empty vanities;
And silent is his sacred lyre,
His soul partakes of chilly sleep,
And of the world's unworthy sons
He is, perhaps, the very least.
Pushkin knew the suffering of the peasants under the Czar’s regime. As a member of the upper Russian social class, Pushkin was never fascinated by its glory. He had a mission in life. Pushkin often used his writing to express the agony and suppression of the Russian people. Hence, he was hated by the regime. But, the general public recognized Pushkin as a great poet and respected him. Gradually he became the envy of the Royal Palace.
Many conspiracies were launched against Pushkin, and finally, he was provoked to engage in a dual. In the ill-fated dual, he was fatally wounded and later succumbed to the injuries. After Alexander Pushkin’s tragic death, Lermontov published an elegy titled Smerta Poeta or The Death of a Poet, which criticized the conspiracy involved in Pushkin’s untimely death.
Alexander Pushkin and Mikhail Lermontov shared many things in common.  
Both were inspired by the novels of Sir Walter Scott. Both demanded social reforms and emerged as spokesmen for literary radicals. Their work provided fertile ground for Russian poets and novelists.  Both had a great influence on later Russian writers. From Gogol to Dostoevsky and from Dostoevsky to Boris Pasternak, their unique influence remained unchanged.
Ironically, Pushkin and Lermontov led reckless and generally cynical lives, but they expressed their inner feelings via prose and verse. Mikhail Lermontov had an influence on Lord Byron, and as a matter of fact, he adopted the Byronic cult of personality. Lermontov’s psychological novel A Hero of Our Time describes a reckless and a cynical character named Grigorii Pechorin.
The central character, Pechorin, is complex in nature. Pechorin is an impulsive, emotionally numbed and manipulative, capable of extreme bravery but generally bored by his life. Pechorin was a hero as well as a renegade, and according to some critics, the central character in A Hero of Our Time could really have been applied to Lermontov himself. Lermontov's best-known poem, The Demon a self-accusing poem,   exemplifies a fallen angel who loves a mortal woman reflecting the poet's self-image as a demonic creature.
Lermontov loved the Caucasus region and admired its natural beauty. The Caucasus had also inspired Pushkin. Their characters were somewhat similar. Both were sensitive, cynical, nihilistic, and possessed extreme arrogance. They stood against social injustice. Like Pushkin, Lermontov was killed in a duel in the Caucasus. Both died at a young age, leaving a deep void in the field of literature. Alexander Pushkin’s and Leonardo's lives can be viewed as some of the most epic and dramatic in the history of literature.

Tuesday, March 19, 2024

Tim Hortons-Double -Double


A KKK Member
A Black Panther 
A Jihad Fighter 
All three came to Toronto
They met near the CN Tower
Decided to challenge each other   
They all went to Tim Hortons
Before starting their violent debate 
They ordered three  medium coffee 
Specifically said  - Double -double 
They enjoyed their coffee 
With Boston Cream Donuts
After finishing their coffee   
They instantly became friends 
They embraced each other 
Then agreed to renounce violence 

Saturday, March 16, 2024

Hey Dorothy where are you


Hey Dorothy where are you 
Where is Toto - the dog that you loved 
Have you been to the magical Land of Oz
How did you escape from the wicked Witch of the East 
Whose hand savaged the  Munchkins

Your  magical Silver Shoes are shining 
You may be heading to the Emerald City 
Wanna meet the great and powerful Wizard of Oz 
Then walk on the yellow brick road

I see you walk with the Scarecrow  
When you meet the Tin Woodman
Pour some oil on him 
He would walk with you 

Do you hear the Lion's roar
He is harmless -a cowardly Lion
He needs confidence and care 
Join hand in hand with him 

The  Scarecrow wants a brain
The Tin Woodman wants a heart
The Cowardly Lion wants courage
What do you need Dorothy
Anything special 

Be cautious-  you are being watched 
The wicked Witch of the West sees you
She might send the Winkie soldiers 
Ask the  Cowardly Lion to strike 

Dorothy your bucket of water 
Melted the Witch
She said What a world 
What a world 
It was an end of an era 
An era of tyranny
Ruwan M Jayatunge 

Friday, March 1, 2024

නිහාල් සිල්වා ගේ මරණය ඝාතනයක් ද ?


කොන්ස්පිරසි තියරි සඳහා මිනිසුන් තුල අභ්‍යන්තර ආශාවක් පවතියි. නිහාල් සිල්වා ගේ මරණය එලෙස කොන්ස්පිරසි තියරියක් ගොඩ නැංවීය​. නිහාල් සිල්වා  1989 දෙසැම්බර් 03 වෙනිදා රාත්‍රියේ දෙහිවල, ගාලු පාරේ, විලියම්ස් හංදියේ දී හමුදා මුර පොළකදී අණ නොතකා ධාවනය කිරීම නිසා වෙඩි වැදී මිය ගියේය​. මිය යාමට ප්‍රථම නිහාල් ජනාධිපති ප්‍රේමදාස ගේ සමීපතයෙක් විය​. මේ නිසා නිහාල් ගේ මරණය සමග බොහෝ කතා කරළියට පැමිනියේය​. 

 නිහාල් සිල්වා පැමිණියේ කොලඹ අඩු ආදායම් වත්තකිනි. ගෙන්දගම් පොළවේ සමාජ ආශරයෙන් ඔහු චරිත පිලිබඳව ඉගන ගත්තේය​. ඕනෑම ලූම්පන් චරිතයක් , සුළු ජාතික චරිත ( සාජන්ට් නල්ලතම්බි - ද්‍රවිඩ / හිරු නොසැලී සිටියේය නාට්‍යයේ මුස්ලිම් මුදලාලි ) රඟපෑම​ට ඔහුට හැකි විය​. එකී සෑම චරිතයකම සියුම් අන්තර්ගතයන් , ගතිකයන් , කථන විලාස ඔහු අති දක්‍ෂ ලෙස ග්‍රහනය කරගෙන සිටියේය​. එසේම පුන්තිලා වැනි නාට්‍ය වල බැරෑරුම් චරිතද ඔහු දක්‍ෂ ලෙස  රඟපෑවේය​. මිය යන විට ඔහු සිටියේ ජනප්‍රියතාවයේ හිණි පෙත්තේය​.

බොහෝ නළුවෝ දේශපාලකයා පසුපස බළු කුක්කන් මෙන් යන විට දේශපාලකයා කෙලින්ම නිහාල්ව තමන් වෙත කැඳවා ගත්තේය​. නිහාල් ගේ සමාජ ප්‍රාග්ධනයේ වටිනාකම ඔහුගේ සන්නිවේදන හැකියාවන් ඔවුන් අවබෝධ කර ගෙන සිටියහ​. මාධ්‍යවේදී නන්දන වීරරත්න පවසන අන්දමට නිහාල් සිල්වා ගේ මරණය ඝාතනයකි. එය පසු පස සිටින්නේ ජනාධිපති ප්‍රේමදාසය​. ජනාධිපති ප්‍රේමදාස බොහෝ දෙනෙකු ස්වර්ගස්ථ කල බව සැබවි. එහෙත් නිහාල් සිල්වා ගේ මරණය කොන්ස්පිරසි තියරියක් හරහා ජනාධිපති ප්‍රේමදාසට බැර කල හැකිද ?

නිහාල් සිල්වා ගේ මරණය පිලිබඳව මම බොහෝ දෙනෙකු ගෙන් විස්තර විමසුවෙමි. අවසානයේදී තර්කානුකූල විස්තරයක් මට ලැබුනේ අදාල මුර පොල භාරව ක්‍රියා කල මේජර් මහින්දන් සීවරත්නම් ගෙනි . මේජර් මහින්දන් සීවරත්නම් වර්තමානයේ කැනඩාවේ ජීවත් වන අතර එවකට ඔහු ලුතිනන්වරයෙකි. භීෂණ කාලය නිසා මුළු ජන ජීවිත විපරීතව තිබුනේය​. සාමාන්‍ය ජනයා ගේ සිට සාමාන්‍ය සොල්දාදුවා දක්වා පිරිස් සිටියේ ආතතියකිනි. මේ මුරපොලේ සිටි සොල්දාදුවෝ පිරිස් බලය අඩු නිසා දින ගනන් එක දිගට රාජකාරී කිරීමෙන් හෙම්බත්ව සිටියහ​. ඒ කාලයේ ජවිපේ ක්‍රියාකාරකම් උත්සන්නව තිබූ නිසා ඔවුන් සිටියේ සැකයෙනි.

ජනාධිපති ගේ සමීපතයෙකු නිසා නිහාල් සිල්වා සිටින්නට ඇත්තේ ගැම්මකිනි. එය ස්වභාවිකව ඕනෑම පුහුදුන් මිනිසෙකුට ඇති වන මාන්නයකි. ඒ නිසා ඔහු හමුදා මුරපොලවල් පිලිබඳව එතරම් තැකීමක් නොකරන්නට ඇත​. අණ නොතකා ධාවනය කිරීම නිසා හමුදා සෙබලා එම රථයට වෙඩි තැබුවේය​. එහි ප්‍රතිඑලය වූයේ නිහාල් ගේ මරණයයි.

මේ මරණය සිදුවූ වහාම ලුතිනන් මහින්දන් සීවරත්නම් එතැනට ගොස් පොලිසිය සමග ස්ථානීය විමර්ශණයක් කරන ලදි. මහින්දන් සීවරත්නම් පවසන අන්දමට එය විඩාබර සහ ජවිපෙ ප්‍රහාර පිලිබඳ නිරන්තර සැකයෙන් සිටි සොල්දාදුවෙකුගේ වෙඩි පහරකි. ඔහු මෙය ඝාතන සැලැස්මක් යන අදහස ඔහු බැහැර කරයි. නන්දන වීරරත්න පවසන පරිදි එම රථයට වෙඩි තැබීමෙන් පසු  සමඟ එම රියේ ගමන් කරමින් සිටි තවත් මගීන් තිදෙනෙකු වූහ​. මොවුන් තිදෙනාම තවමත් ජීවතුන් අතර සිටිති. කොන්ස්පිරසියක් අනුව වෙඩි තැබුවේ නම් ඝාතකයන්  සාක්‍ෂිකරුවන් තිදෙනෙකු ඉතිරි කරන්නේද නැත​.

ජවිපේ මිනිස් ඝාතන , ප්‍රේමදාසගේ ඝාතන සපිරි යුගයක නිහාල් සිල්වාගේ මරණය කාගේ හෝ ගිණුමකට බැර කිරීම අපහසු කාර්‍යක් නොවේ. එහෙත් අප එදා සිදු වූයේ කුමක් ද යන්න අනාගත පරම්පරාවට දැන ගැනීමට සහ ඔවුන්ට විචාර බුද්ධියෙන් කරුණු තේරුම් ගැනීමට අප සත්‍ය සාක්‍ෂි ඉතිරි කල යුතුය​. 

 වෛද්‍ය රුවන් එම් ජයතුංග 

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